“It wasn’t viable in the way that we did it,” Peck said. “We were very far ahead of the curve.”

Call9‘s founder, Tim Peck, MD, interviewed by local business publication Crain’s New York Business, shed a bit more light on the company’s planned reorganization as Call9 Medical. According to Dr. Peck, Call9 Medical will be in a much larger network of nursing homes and add primary care physicians to its services. The reopened company will be backed by its Silicon Valley lender, Western Technology Investment, which apparently forced the closing issue when the company’s cash on hand fell below the amount lent by WTI. No timing for resumption was given.

In the interview, Dr. Peck returned to reasons why the Call9 original model did not work. Insurers would pay for fee-for-service based telemedicine visits in nursing homes but not pay on their operating concept of fewer hospitalizations and better health outcomes that saved money, which had a longer-term payoff.

Apparently this led to a standoff with controlling (over 50 percent) funder Redmile, which encouraged the FFS revenue stream. “We had to do services in a particular way that in no way brought value to our model,” Peck said. The ‘change in funders’ as noted in TTA’s article on the shutdown now is in a fuller context; Redmile will not be participating in the repositioned company. Confirmed in the article is that a few former investors, WTI, and some former employees will be part of it.

In this Editor’s view, Call9 had trouble accommodating both payment tracks, perhaps because they were overly invested in their concept. In the real world, it seems odd in a company of this size and investment level, which at one point employed close to 200 people and was about 100 at shutdown. Young companies, if anything, learn to be flexible when it comes to getting profitable cash flow into the exchequer, including standing their ground against ‘pilot-itis’–especially when their major investors encourage it.

One of their earliest customers also warned them of another flaw in their model. The author interviewed the CEO of one of Call9’s earliest clients, ArchCare, a Catholic nonprofit LTC organization in New York. ArchCare was able to “get its patients’ hospitalization rates low enough on its own that paying the startup no longer made sense.” “Their model wasn’t able to move the needle sufficiently to justify the ongoing expense,” CEO Scott LaRue explained.

One hopes that Call9 Medical will avoid those pitfalls in being too far ahead of the curve and recast their telemedicine model to improve health outcomes for our most frail, vulnerable, and poorly served. Hat tip to HIStalk.

A newly-released Accenture study on US primary care estimates that savings of about $10 billion per year in US primary care could be achieved through use of ‘virtual health’, defined as “digital tools such as biometric devices, analytic diagnostic engine and a virtual medical assistant” that would allow much of the work of a typical office visit to be done prior to or separately from the visit, and follow up/check in tools such as video visits/telemedicine which would further offset costs. The cost savings were calculated by Accenture Insight Driven Health as a total of time-per-visit savings of five minutes–when aggregated, $7 billion, $300 million in telemedicine visits, telehealth self-management in diabetes alone $2 billion, health system savings $63 million. This could potentially solve the shortage of US PCPs now projected at 31,000 in the next ten years. Nary a mention of patient care savings, chronic care management or telecare for proactive behavioral home monitoring, however. Accenture release (BusinessWire), Accenture page and paper.

Our definitions

Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:

• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.

• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.

Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.